[Radio-carpal amputation and prosthesis]. / Amputation radio-carpienne et appareillage.

Radio-carpal amputation was rejected for a long time because of the difficulties of fitting both myoelectrical and mechanical prostheses, only allowing a purely aesthetic prosthesis. As a result of miniaturization of control systems and the progress in computers, we believe that this now constitutes the best site for amputation whenever it is possible. Preservation of the antero-posterior bony contours of the radius allows the use of short sockets attached by a system of clips. In this way, flexion-extension of the elbow is left free and the movements of pronation and supination can be used. Liberation of the proximal joints facilitates integration of the prosthetic hand.

["Desensitization" technique in the rehabilitation of the painful hand]. / Techniques de "désensitization" dans la rééducation de la main douloureuse.

Hand injury patients fairly frequently develop, soon after the injury, hypersensitivity phenomena on contact of the hand with the environment, which may lead to exclusion of the hand. The authors attempt to explain this syndrome on the basis of the pathophysiological theories concerning pain. American authors have proposed an original desensitization treatment based on simple and varied techniques, which provides extremely encouraging results.

[Total paralysis of the brachial plexus. Value of the preservation of the limb and the restoration of active flexion of the elbow]. / Les paralysies totales du plexus brachial. Valeur de la conservation du membre et de la restauration de la flexion active du coude.

Twenty-six cases of complete brachial plexus paralysis treated surgically have been studied with particular regard to the function of the preserved limb after at least four years. A partial reinnervation was attempted in 27 cases including six neurotisations in the absence of a useful nerve stump. Out of these 28 patients, 14 remained completely paralysed and 14 recovered active elbow flexion equal to or greater than grade 3. Examination of these young injured patients showed that: 1. The preservation of the limb was always preferable to amputation which was only requested by one patient. 2. Active flexion of the elbow greatly improved the functional result by allowing certain types of holding and gripping activity and the ability to put the paralysed and insensitive hand into the pocket or supported on a surface. It also limits downward dislocation of the shoulder which is often painful.

[Pain following traumatic lesions of the brachial plexus (radicular avulsions and truncular lesions)]. / Les douleurs après lésions traumatiques du plexus brachial (avulsions radiculaires et lésions tronculaires).

Pain in avulsions lesions of the brachial plexus is related with deafferentation; experimental studies demonstrate that spontaneous discharges can be recorded with micro electrodes in the dorsal horn, after division of the dorsal roots. These discharges ("firing") are related with the loss of control of the inhibitory effects of the large caliber sensory fibers. This pathophysiological concept drawn from the Melzack and Wall's theory (gate control) allows a good meaning of the paradoxical results observed after neurotization (via accessory or intercostal nerves), namely immediate relief of pain, observed in several cases after surgery. This theory helps to explain the efficiency of the neurostimulation techniques (by inhibition of the "firing") and of the technique of "dorsal root entry zone coagulation" in the avulsed area, on the spinal cord, by direct destruction of the hyperactive cells in the posterior horn. These technical advances and early return to work and to community offer the best prospect of relief of pain. Incidence of intractable pain problem is less than 10% after 10 years.